ESSAYS IN MANAGEMENT
BEFORE YOU START – these essays were written under exam conditions and are not perfect! just what
you might offer in paper Ib, usually at question 10. Each essay is on one item in the syllabus, taken as a
direct quote from the syllabus rather than a specific question. In the exam read the specific question
carefully.
I’ve added some comments to let you know what I was thinking as I went along.
Contents
Evaluating internal resources and organisational capabilities [504 words] ......................................................... 2
Identifying and managing internal and external stakeholder interests [576 words] .......................................... 3
Structuring and managing inter-organisational work, including intersectoral work, collaborative working
practices and partnerships [580 words] .................................................................................................................... 4
Social networks and communities of interest .......................................................................................................... 5
Social networks [282 words] .................................................................................................................................. 5
Communities of interest [211 words] ................................................................................................................... 5
Assessing the impact of political, economic, socio-cultural, environmental and other external influences
[495 words].................................................................................................................................................................... 7
Creativity and innovation in individuals and its relationship to group and team dynamics; barriers to and
stimulation of creativity and innovation [526 words]............................................................................................. 8
Learning with individuals from different backgrounds [493 words] ................................................................. 10
Personal management skills (e.g. managing: time, stress) [578 words].............................................................. 11
Managing difficult people [400 words] ................................................................................................................... 12
Managing meetings [474 words] .............................................................................................................................. 13
Effective communication [552 words] ................................................................................................................... 14
Evaluating internal resources and organisational capabilities [504 words]
The internal resources of an organisation many conveniently be classified as human, financial and
physical.
The human resources of an organisation are its staff, both those directly employed and those within its
sphere of influence. The latter include, for example, people who could be leveraged during a campaign or
lobby for public opinion or political action. Human resources include knowledge, skills and contacts. In
public health the most obvious forms of knowledge are epidemiology, knowledge of social sciences,
health protection and management. Relevant skills are those set out in the Faculty’s curriculum including
domains of health protection, promotion, intelligence, health service commissioning and research
(academic public health).
It is worth considering how these skills can be identified. Formal skills should be obvious from job
qualifications, for example for accountants or public health specialists. Less obvious skills may require
some form of survey, though getting accurate, truthful answers may be difficult and keeping such
registers up-to-date against staff turnover is well-nigh impossible. Identifying ‘people skills’ may require
use of questionnaires such as Belbin or Myers Briggs.
Turning to the financial resources of an organisation, we need to remember not only the budgets directly
controlled but also those we can influence. Such influence can take many forms, from closely tied (e.g.
pound for pound matching schemes) through influencing spend by membership of powerful committees
(perhaps grant awarding committees) to a very loose influence on the mood of government (for or against
central institutions, for example).
Financial resources also include extra funds we could bid for, either locally or at European level. These
resources are of course not guaranteed but may be substantial. We should also not forget resources in
kind – mostly staff time. This is common in matching schemes – for example the European Union may
require 40% co-funding of projects but this can be the time of public health consultants.
Physical assets include building and equipment. The ability to provide a venue for meetings is hugely
important- meetings are a key part of public health work but getting rooms in accessible venues such as
city centres is very expensive. Capacity to photocopy can be important and many office resources are part
of what public health organisations can bring to partnership work with small charities or patient groups.
Delivery of public health programmes may require some very specific resources e.g. large equipment such
as mammography machines or stockpiles of anti-flu drugs and masks.
Organisational capabilities flow from the resources outlined above of staff, finance and physical kit.
Evaluating rather than just listing these resources can be conveniently undertaken with a framework of
SWOT – strength, weakness, opportunity, threat. This may, for example, be relevant to PCTs today .They
have strengths in commissioning and direct delivery of services such as health visiting and smoking
cessation, but weakness in the lack of GP involvement at the heart of the organisation, which is a threat
given the current government’s intention to place GPs at the centre of commissioning. (This weakness
may perhaps be mitigated in some places with strong Professional Executive Committees.)
Identifying and managing internal and external stakeholder interests [576
words]
A stakeholder may be defined as anyone (or any organisation) that can help or hinder our plans; or may
be affected by them. We need to consider how to (a) identify and (b) manage these stakeholders.
A convenient framework for indentifying stakeholders is to think of these as above, alongside or below us
in a hierarchical framework.
For a local health organisation external stakeholders hierarchically above us include regional and national
organisations. Thus a PCT in England need to consider its Strategic Health Authority. National
organisations include government departments, most obviously the Department of Health but sometimes
others such as the food ministry (for contaminated food incidents) or the Home Office (for policy on
illegal drug users). Other important national organisations are the medical Royal Colleges (for health
policy) and the General Medical Council, organisations such as NICE and the Health Protection Agency.
Managing these organisations above us in a hierarchy generally depends on establishing relationships with
relevant officials before trouble strikes. Most national organisations are keen to keep an ear to the ground
and will welcome opportunities to make links to staff at the front line.
The organisations ‘alongside’ us are local partners. This includes neighbouring organisations of the same
type (e.g. other PCTs) or organisations covering the same geography (local government). Managing these
stakeholders will typically involve formation of collaborations and partnerships. These are based on
common objectives which may be general (e.g. improving the locality with local government) or more
specific (joining other PCTs to lobby the SHA or to plan region wide services such as cardiac surgery).
Organisations ‘below’ us are those with more limited remit, either geographically or in scope. This would
include small local charities such as housing associations or groups concerned with a specific disease
(rather than the whole scope of the NHS). The characteristic mode of managing these stakeholders
should be supportive and consultative. It is all too easy to bully lesser organisations. So small
organisations need to be given opportunities to meet health bureaucracies face-to-face as well as to
interact through websites and so on. Local health organisations need to explain their policies and
procedures clearly enough for other weaker organisations to be able to challenge them meaningfully.
Let us now turn to identifying and managing internal stakeholders. To a large extent this will depend on
the structure of the organisation. In an organisation with divisional form (e.g. finance, public health,
commissioning) managing up will tend to be through one’s own director. It would be unusual for a public
health specialist, for example, to deal directly with the finance director: such interaction is usually (public
health) director to director. This illustrates another rule of managing stakeholders, which is to match like
with like. Finance personnel and public health people are socialised into their job roles in very different
ways,. And so the most effective interactions are finance: finance and public health: public health.
Likewise an doctor may be needed to manage stakeholder relations with the medical profession.
Stakeholders ‘below’ us organisationally are support staff, who are typically involved because (a) they are
about to be affected by a re-organisation or (b) we need their input to deliver on a project. These two
scenarios call for different management techniques.
Managing a consultation requires a constant stream of communication to quash rumours and as far as
possible lessen uncertainty.
Managing a project involves more straightforward management techniques for internal stakeholders such
as assigning tasks, setting deadlines and monitoring progress.
Structuring and managing inter-organisational work, including intersectoral
work, collaborative working practices and partnerships [580 words]
“Inter-organisational” work denotes work between two or more organisations, but this begs the question
of what constitutes an organisation. Is the NHS one organisation or many? Certainly there are many legal
entities in the NHS but as a whole it has common purpose, and a widely accepted definition of an
organisation is a group of people with a common purpose. Gray has pointed out how fluid the
boundaries of an ‘organisation’ are; within a single legal entity there may be several organisations, hosted
or otherwise.
The key problems of organisational work arise from differences in aims, but also differences in culture.
Thus the NHS has great freedom to spend taxpayers money on anything vaguely related to health;
whereas local government may only spend money if the law explicitly allows it. This leads to very
different culture and attitude in committing expenditure. A key feature of successful partnership is to
explore and understand cultural difference early. These differences will be obvious to staff who have
worked in both organisations (e.g. move from local government to the NHS) but when entirely new
alliances are formed (perhaps internationally) discussion of culture must be built in to the agenda.
Differences in aims are perhaps more obvious. In work on drug abuse, for example, the primary aim of
police forces is to prevent crime and arrest criminals; the primary aim of health services is to prevent
health damage. Of course imaginative work may reveal common or shared aims: rehabilitating a drug user
will lead to less crime. Exploring such common goals is a key way to manage partnerships.
Attention to language is also important. This is obvious in international work, where interpreters may be
required at meetings, but subtle differences can cause difficulties within the UK. ‘Needs assessment’ for
examples tends to focus on individual statements of need when used by social services, but has a
population focus when used by public health staff.
Some typography or classification of inter organisational work is useful. This work can be structured as an
alliance, a collaboration or a partnership. An alliance is a loose grouping of organisations working in
similar fields. Umbrella groups such as the ABPI for pharmaceutical companies, or the Genetic Interest
Group for patient organisations are alliances. Their work is structured by rules of membership, and work
may focus on agreeing to conform to certain rules or standards (such as the ABPI code of practice). The
GIG may wish members to sign up to certain policy statements or objectives.
Collaborations imply a closer mode of working between a smaller number of organisations (perhaps two
or three) around a particular project.
Research collaborations are a good example. Several research teams may bring expertise to a project – for
example clinicians, epidemiologists and laboratory scientists may collaborate to tackle a specific research
question for a disease e.g. vaccines for HIV.
The closest form of collaboration is a full partnership, which may include shared budgets. Such
interorganisational work will need to be very highly structured with detailed rules of operation and clarity
about liabilities. A unified management structure may be created with a single chief executive. But the
partner organisations will each be represented on the oversight Board or committee. A particular problem
with this type of arrangement is ensuring continuity of representation in the joint Board from the partner
organisations. Joint Action Teams to tackle health and social problems in a local area (for example Sure
Start projects) are an example of this type of inter-organisational work.
Social networks and communities of interest
..
Social networks [282 words]
Social networks are networks of people. Like all networks they consist of nodes, and connections
between the nodes. A number of different forms of network are possible and their characteristics can be
formally analysed mathematically. Points of particular interest are (a) the number of connections from
each node and (b) the social distance from one node to another. Both indicate the density of the network,
or how well people in a network know each other. Innovations, both bad and good, should spread
quickly in a densely connected network.
Recent research on the Framingham cohort has shown that obesity appears to spread through social
networks. Thus people become obese if their close social contacts become obese. Earlier work in the
1960s showed that prescribing of a new drug (tetracyclin) also followed processes of social influence: a
group of doctors in a small town were asked to map their social networks and analysis showed that the
pattern thus described followed the pattern of innovation
Networks may be centralised or dispersed:
[here I drew a diagram a bit like this one:
plus another one with the nodes strung out more]
In a centralised network, the person in the centre obviously has great influence, but the network is
vulnerable to his loss. Dispersed networks are more robust to change but less easy to control.
It should be noted that the formal structure of an organisation – its ‘wiring diagram’ – showing hierarchy
of chief executive, directors and so on down to the admin support staff – may be very different from the
social structure through which influence flows. At this point friendships, common background,
membership of clubs and so on become more important. At its most extreme an admin assistant who is
the wife or lover of the chief executive will wield more influence than many senior managers.
Communities of interest [211 words]
‘Communities of interest’ are also known as ‘invisible colleges’. These are groupings of individuals who
meet, either physically or virtually to discuss and from common opinion on their shared interest. The
classic example is a national or international collaboration of doctors treating a disease, for example,
muscular dystrophy. Organisation charts will not reveal these ‘invisible colleges’ since members hold
posts in disparate organisations. Sometimes these communities of interest will go on to become formal
organisations either nationally (e.g. the Association of British Neurologists) or internationally (e.g. the
International Epidemiological Association). Perhaps the most famous is the Cochrane Collaboration
which started as an informal, unfunded grouping of people with an interest in evidence based medicine
and systematic reviews.
Funding may be a problem for communities of interest particularly if physical meetings are required. For
doctors, funding is often provided by drug companies, raising a strong chance of bias in any consensus
developed.
Another form of community of interest is the alumnus group of a university. This is perhaps a particular
form relevant to managers who have done an MBA together. Managers, unlike physicians, have little
tradition of forming communities of interest.
Organisations may form umbrella groups but these more formal associations are not what is meant by the
term ‘community of interest’.
Assessing the impact of political, economic, socio-cultural, environmental and
other external influences [495 words]
Political
The political context for management includes both national (party) politics and medical politics. The
former are particularly obvious at present with the change of government. A key question is where power
lies – at the centre or locally? With doctors or managers? The coalition government is seeking to place
power with doctors and locally, though any political analysis must distinguish between headline
statements by politicians in newspapers and the realities of life dictated by who controls the reward
systems: if managers at the centre can fire local managers, power remains central.
Medical politics refers to issues of loyalty and emotion that may override dispassionate analysis. These
factors become prominent during reconfiguration - for example the attempt to close a local specialist
service such as burns.
Economic
Economic factors are important in any managerial analysis. They include broad economic questions of
choice and allocation of scarce resource, as well as detailed financial costings. Broader economic
techniques include option appraisal and decision analysis, and may incorporate societal views as well as
those of the health service. The key point about economic analysis is that it informs, but does not dictate,
the decision. Thus a health technology appraisal at NICE may indicate a cost per QALY above the usual
threshold of £30k, but if the drug is for the otherwise untreatable motor neurone disease, the decision is
‘yes’. The non-financial techniques of option appraisal and decision analysis are an important part of
procedural justice: decision criteria are made explicit and judgements open to scrutiny. These are
particularly useful in complex multi-option scenarios such as where to locate a new hospital.
Social cultural
The social and cultural norms of a population will help to determine managerial choices. A classic
example is the location of childbirth – hospital or home, British culture is overwhelmingly informed by an
NHs “Free at tht epoint of use” which stifles any useful debate or consideration of co-payment, even for
services widely bought in the private sector (e.g. up to 25% of elective surgery in Williams’ survey). Other
social and cultural norms of increasing importance are those associated with religious belief, both at the
beginning (circumcision) and end (assisted suicide) of life. Some social and cultural norms will be
incorporated in law (e.g. abortion). Attitudes to organ donation is another example.
Environmental
The physical environment affects management planning .Perhaps the most dominant is distance – many
health service decisions and policies are affected by travel time. It is well known that use of a health
facility decreases with distance so efforts to improve equity of access must include outreach – home care,
shared clinics and so on. During the 1980s and 1990s the development of satellite dialysis units did much
to improve equity of coverage for end stage renal failure.
Other aspects of the environment are climate- heat, cold, drought and flooding. These are not often
relevant to the NHS in its normal running but contingency plans are needed and of course these factors
are hugely important globally.
Creativity and innovation in individuals and its relationship to
group and team dynamics; barriers to and stimulation of
creativity and innovation [526 words]
Creativity is easy to recognise but hard to define. Roughly speaking it is the introduction of new or
unexpected ideas, and in a management context these ideas are directed at tackling problems.
The key barriers to creativity and innovation are fear and lack of imagination. Fear includes fear of change
and fear of criticism. Any change will produce both advantages and disadvantages, so opponents of
change and innovation can highlight the disadvantages. Meanwhile proponents of change must create a
compelling vision of a better future. A common mistake is to focus on mechanics of the change rather
than the benefits which will flow. Change is disruptive and it requires persistence to see the change
through and realise its benefits.
Because fear of criticism is such an important barrier to creativity, an important rule of brainstorming and
other techniques to stimulate creativity is to allow no criticism, or even comment, while ideas are being
generated. Belbin’s work on management teams showed very clearly how criticism lowers team
performance: his ‘A’ teams, selected for the high IQ of their participants, performed poorly against teams
less able intellectually because in the A team any udea offered was immediately critiqued by all other
members of the team.
In organisational innovation the key fear is of course job loss. This powerful barrier is to some extent
inevitable but its effect is lessened by good procedural justice – all players need to know that fair and
open procedures are being used. They also need to understand the rationale for the innovation. Both
factors call for strong and open communication with employees.
Various strategies have been used to overcome lack of imagination as a barrier to creativity. Some are
labelled ‘right brain’ activities in the belief, largely unsupported by evidence, that the right cerebral
hemisphere, because it is the location of spatial awareness, is more creative than the left hemisphere
where the language area is located. ‘right brain’ activities include play and art. Thus participants may be
asked to draw the problem as a way of unlocking ideas. Similar rationales underlie games in which
participants are asked questions such as “If this organisation were an animal, what animal would it be?”
A drawback of these methods is that they do not appeal to doctors, who regard them as mumbo jumbo.
This discredits the managers who use such techniques. Indeed doctors trained in evidence based medicine
and hard fact may have difficulty with any creative effort.
One technique for innovation which does not have this key drawback is knowledge management.
Sometimes innovation means not reinventing a wheel. Knowledge management systems include the
published literature, but also ‘grey’ literature documenting projects and initiatives. Google has made it
very simple to access much of this literature but quality assurance remains a problem. Also, capturing
knowledge from experience which has not been written up is a challenge.
The characteristics of a successful innovation were documented in Ryan and Gross’ classic study of the
introduction of a new type of corn to Iowa farmers in the 1930s. These formal characteristics were:
Observable benefit
Compatible
Simple
Trial
Relative advantage
Finally innovation requires someone to drive it forward – the product champion.
Learning with individuals from different backgrounds [493
words]
.
People arrive at learning opportunities with different mixes of aptitude, knowledge, experience and
personality. This mix influences the nature of learning with individuals from differing professional
backgrounds. This is particularly relevant in public health, an inter disciplinary specialty which has always
recruited people from a wide variety of backgrounds. It is convenient to consider separately didactic
learning from experiential.
Didactic learning typically takes the form of classroom teaching. Prior experience and knowledge mattesr
– learners become bored if told stuff they are already very familiar with. This is okay for short periods but
not over a course of lectures. One solution is to stream pupils within learning sets by creating selfcompletion tests and exercises of varying complexity, though such learning materials are time consuming
to create and keep updated.
Aptitude also matters. Staff from finance backgrounds will typically be very good at number work and
hence statistics; those from a social science background less so. This problem is lessened to some extent
by entry criteria to courses or other learning programmes. Sometimes this is a requirement for a degree
for certain GCSEs; or it may be by aptitude tests. Thus recruitment into public health training enforces a
basic level of aptitude in mathematics by tests at recruit selection.
Personality also affects learning experience. The work of Myers Briggs showed that not only can we
distinguish different personality types but also that certain jobs select (or form) certain personalities.
Myers Briggs’ example was police officers and university administrators but we can imagine that the same
would apply if surgeons and hospital administrators learn together. These differing personalities will
present as preferences for learning by private reading versus class discussion, and as differences in the
need for certainty or ambiguity.
Thus far we have considered some of the problems of learning with people of differing professional
backgrounds. But there are also of course great advantages if the teacher can draw out differing
experiences, particularly if the learning objective is more in the area of behaviours and judgements rather
than facts. Discussion of anatomy is divisive to the group because you either know the facts or not; but a
discussion of ethics will be enriched by differing points of view.
A learning set, with case based teaching, may be the best way to draw out these benefits, though group
processes require close attention to get the best out of everyone. One solution is to form the group with a
learning experience which sets everyone at the same level – for example outdoor tasks of walking or
camping where previous professional experience is irrelevant.
Finally we need some consideration of learning styles. The literature on learning styles (‘activist’,
‘pragmatist’ etc) has been heavily critiqued. Undoubtedly some people are much more visual than others
and in classroom teaching prefer diagrams, charts and models. Others are word or number based and
prefer tables of data or lists. It is however not clear that these preferences are systematically related to
professional background.
Personal management skills (e.g. managing: time, stress) [578
words]
Any discussion of how to manage stress requires first some definition of ‘stress’. In the Whitehall II
studies, stress was operationalised as imbalance in two axes: demand / control and effort / reward.
Managing stress thus implies reducing demand or effort; or increasing control and reward.
There are a number of strategies for reducing job demands; two key skills are prioritising work, and
assertiveness (the skill to say ‘no’). Prioritising involves sorting urgent work from important work.
Stephen Covey’s popular work ‘Seven habits of effective people’ included a basic time management
system to ensure that urgent tasks (including taking phone calls and answering emails) do not crowd out
important work (time for reflection and strategic thinking). Prioritising time also means not attending
numerous unproductive meetings.
Assertiveness is different from aggressiveness, but it means establishing limits. If your manager piles on
more and more demands, assertive questioning – ‘which of these is most important?’ – becomes essential.
A project plan can help; ‘which of these activities would you like me to defer?’. Or assertively requesting
more resources needed to do the task – ‘happy to do that but I will need an assistant’.
Control can be increased by several mechanisms. Of course in public health workload can sometimes be
unpredictable but the most basic tool of control is a contract, which limits to the hours you work – you
control your working time. The European Working Time Directive has increased employees’ control over
their lives in this respect. Lesser forms of contract which help to set limits and increase control include a
simple written memo setting out what has been agreed. Good managers allow exmplyees maximum
autonomy to achieve objectives, and concepts such as ‘earned autonomy’ – greater freedom in return for
better performance – an indeed ‘management by objectives’ (as opposed to ‘management by detailed
procedures’) reflect this.
Effort may be physical or mental. Tools and equipment reduce physical labour but in public health
mental effort is the main target. Concepts such as ‘working smarter’ in the ‘knowledge economy’ are
relevant: one key to reducing effort is first class IT equipment with fast servers and broadband. This
reduces the effort required to locate and use knowledge.
Rewards include not just money but also recognition and, as Maslow pointed out, .self actualisation. So
stress can be managed by recognising effort – sometimes this is as simple as remembering to thank staff
for a job well done. Other more public forms of reward include award ceremonies. One drawback of
non-pay rewards is that they may have to be repeated in novel forms to maintain their worth.
Antonovsky offered a different perspective on stress following his work on Holocaust survivors. He
proposed that surviving stressful situations depended on a ‘sense of coherence’ – the world must be
understandable, manageable and meaningful. Thus in managing a stressful situation such an organisational
downsizing it is important, to reduce stress, that everyone understands clearly the rationale for the change
and for specific decisions such as who gets made redundant. ‘Manageability’ of the change is allied to the
sense of control mentioned above but would include for example retraining, advice on job hunting and
help with applying for early retirement. For holocaust survivors ‘meaning’ was given to their experience
by a determination to survive so that their story could be told afterwards. Meaning may perhaps be found
in the much less stressful circumstances of public health work by an attitude that all experiences are
learning experiences which may come in useful later on.
Managing difficult people [400 words]
..
People may be difficult to manage for two main reasons – lack of interpersonal skills, or poor
performance. In both cases managing includes prevention and remediation.
Prevention starts with good recruitment and selection. Poor performance should be obvious from the
candidate’s CV if appraised thoroughly, and if selection is based on what the candidate has actually
achieved rather than glib answers to interview questions. Difficulties with interpersonal skills may also be
evidence from references. Nowadays many candidates, including most doctors, will have undergone
multisource feedback exercises and information from these should be as important a feature of CVs as
exam results. Finally many recruitment processes include group work which may reveal interpersonal
skills (or a lack of them).
Remediation of poor performance can follow standard performance management techniques, specifically
the setting of clear objectives – specific, measureable, achievable, realistic and timed. If an employee fails
to meet objectives consistently the ultimate sanction is fire him or her. Before that, some investigation as
to the reasons for failing to meet objectives is needed. It may be a lack of training, or perhaps problems at
home such as a sick relative or family breakdown. Ill health, including drug and alcohol abuse, can lead to
difficult and defensive behaviour so an opinion from the occupational health department can be useful.
Difficult behaviour – rudeness, lateness or sullen resistance – is more difficult to manage than poor
performance. The general principle is to focus on the specific problem rather generalising; and to
emphasise the effect on others of the problem behaviour. Thus “when you use swear words, I find it
difficult to focus on my work” not “ you are a foul-mouthed nasty person”.
Ideally this feedback to a person should happen immediately the poor behaviour is noted, but that can be
difficult to achieve, especially during a large meeting. Feedback is best given 1:1 and in private rather than
in front of others.
Some forms of difficult behaviour will contravene the organisation’s disciplinary policy and perhaps also
the law – racism and sexism are obvious examples. These examples also show the importance of
confronting difficult behaviour rather than hoping it will go away. Managers should look to their human
resource departments for help in tackling this type of problem.
The difficult employee may be unaware of the problems he or she causes. A multisource feedback
exercise can help to bring the problem to awareness and allow fruitful discussion.
Managing meetings [474 words]
There are three phases to managing a meeting – before, during and after.
Before the meeting includes deciding the agenda, inviting attendees, and selecting a venue. The agenda
should be ordered so that urgent items do not crowd out important items. Traditionally regular meeting
start with welcomes and apologies follow by agreement to the record of the previous meeting, and any
matters arising. This standard pattern, if not controlled, can lead to reopening of closed debates and
failure to discuss important new items. It is good practice to indicate clearly on the agenda which items
are the most important, perhaps by showing opposite each time an indicative timing.
The agenda should also indicate clearly why each item is there – for example for information only or to
agree a decision. Papers accompanying the agenda should set out options for any decision. The
paperwork must be send out several days in advance to allow participants not only to read them but also
to consult others as necessary.
Attendance at any meeting should be limited to the minimum needed for the business in hand. Large
meetings are difficult to control but equally political processes require that all stakeholders are properly
represented. Managing a large meeting requires the organiser to sound out key participants in advance to
establish their likely contributions.
The venue will contribute to the success of the meeting. A hot airless room makes everyone tetchy.
Visibility and audibility matter – it must be possible for every member to see and hear all other members.
Access for wheelchair users may be required. Food and drink are essential if people have travelled far to
get to the meeting.
The seating plan also requires some thought. It is not a good idea to put opponents facing squarely
opposite each other – this reinforces the antagonism. Friends and colleagues will sit together if not
broken up by place names.
During the meeting it is the chairman’s task to ensure that the agenda is covered in the time available, and
that contributions are elicited from all members. The chairman must sum up on behalf of those present,
and seek consensus if possible. If opinion is plainly divided the chairman must decide whether to settle
the matter with a vote or defer for further discussion outside. Belbin pointed out the key role of a
Chairman in good team performance. Other roles are also required – for examples stimulating thinkers
(plants), people who will attend to the emotional requirements of others in the meeting (team workers)
and people who will ensure followup action (completer finishers).
Also during the meeting rules of procedure, for example quorum and voting rights, should be clear.
After the meeting follow up is important. The first task is to circulate a record of the meeting for
members to agree. This should include a highlighted list of actions – by whom and by when.
Effective communication [552 words]
Communication may be verbal or non verbal, and written or not. Non verbal communication includes
tone, appearance, and body language of speakers; it also includes images both still and movie.
Let us start by considering non verbal written communication. There have been many guides to writing
well, including Gowers’ ‘Plain English’ and Orwell’s famous essay on style. Tim Albert developed a
doctrine of ‘effective’ communication which pointed out that literary style must be subordinate to
producing the desired effect in readers. All authors emphasise the importance of using short sentences
and short words – for example in writing on ethics use ‘good’ and ‘harm’ not beneficence and
maleficence. But Albert also emphasised the importance of matching the style to the readership, especially
be getting feedback on a draft from typical members of the target group – and not, for example, superiors
in the office who may differ substantially from the target audience in both knowledge and outlook. These
concepts of writing to the defined audience are difficult to implement well if the document has many
readerships; this is recognised in websites such as NICE’s which have separate sections for professionals
and for the public.
Non verbal aspects of written communication include font style and size, but more importantly graphic
content. A study in East London several years ago showed how graphics may undermine the text of a
leaflet: in a series of pamphlets emphasising the need for female assertiveness in sexual encounters the
accompanying cartoons showed almost without exception male dominance – men standing over women,
men bigger than women and so on.
Even the medium used for a communication conveys a message, as MacLuhan pointed out in the 1960s.
For examples teenagers may respond better to a blog or tweet than a formal letter; more obviously serious
scientific content is expected in the journals of a professional society rather than, say, the Health Service
Journal.
We can now turn to spoken communication. The spoken word has different conventions because
listeners cannot track back to read again passages they do not understand. Hence repetition and simplicity
are keys to effective speeches. We may however apply Albert’s doctrine here too – a beautiful speech is
not necessarily an effective one. Rhetoric is the study of speeches but there is little academic research on
the subject in modern times.
Non verbal aspects of spoken communications include tone, volume, the appearance of the speaker and
body language. It is often said that communication is only 20% verbal and 80% non verbal but this
statement is based on research by Mehrabian in the 1960s which has very limited application. His study
gave students in a laboratory setting single words to speak. Nevertheless this work has usefully drawn
attention to factors other than the text. In public health these aspects form an important part of media
training: listeners must above all perceive the speaker as trustworthy.
Finally we may consider strategic aspects of communication. Communication planning should include
what, where, when and how. A list of important stakeholders should be drawn up and plan for contacting
each developed. Key stakeholders should be briefed early, and key messages or ‘lines to take’ written.
Press releases may be drafted in advance to deal with various contingencies. Social marketing campaigns
have shown both the importance and the effectiveness of consistent, well developed communication
strategies.